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Basic Image Review

1. Furthermore there will never be fewer FrameSets than Series i e Series will not be combined See Appendix F for informative examples of organization of series and images into frame sets Whether or not an image is single frame or multi frame is independent of the actual SOP Class and IOD of the image A single frame image is defined to be one in which Number of Frames 0028 0008 is absent or present with a value of one A multi frame image is defined to be one in which Number of Frames 0028 0008 is present and has a value greater than one The initial default layout shall include e a strip or panel of FrameSet thumbnails see 4 16 4 2 2 5 3 Navigation e after the user selects the FrameSet to display one or more viewports open each with a single tile populated with an appropriate default image from a default FrameSet eo the first or middle image of the first FrameSet full image size scaled to fit the tile appropriately windowed see 4 16 4 2 2 5 4 Windowing and Rendering and appropriately decorated with annotations see 4 16 4 2 2 5 8 Annotation of Demographics Location Timing and Technique and with the Scrolling tool activated 30 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR e a toolbar palette or panel of tools to access the functions described in 4 16 4 2 2 5 using the icons
2. XDS for Imaging XDS ITI Document Consumer Document content Document Registry and Document Repository actors from ITI XDS are required for XDS I types and metadata are specialized Amend the following section as shown 2 1 13 Portable Data for Imaging PDI The Portable Data for Imaging Integration Profile specifies actors and transactions that allow users to distribute imaging related information on interchange media The intent of this profile is to provide reliable interchange of evidence objects and diagnostic reports for import display or print by a receiving actor A single physical transport means is specified that supports the multiple usage scenarios described in this profile The CD format was chosen for supporting the described use cases The Portable Data for Imaging Integration Profile also allows for viewers to be present on the media The Basic Viewer Option requires that there be at least one viewer present on the media that implements the Basic Image Review Integration Profile 130 Add the following new subsection in section 2 1 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR 2 1 24 Basic Image Review The Basic Image Review Profile defines baseline functions and user interface relevant to simple review of DICOM images Though the Profile is potentially applicable to all Image Di
3. 1025 1030 1035 1040 1045 1050 IHE Radiology Technical Framework Supplement Basic Image Review BIR The cine tools shall be invoked as a group by a single tool button rather than all visible by default on the main tool bar or panel The cine play shall immediately be initiated without requiring the user to press the play button The cine tools shall remain available once activated until explicitly closed by the user Cine of multiple viewports simultaneously is not required but may be provided e g for cardiac applications in which synchronization by cardiac cycle position may also be useful Cine of a tiled viewport snaking cine shall not be used If the cine tools are invoked on a tiled viewport the viewport shall be changed to a single tile 4 16 4 2 2 5 10 Measurements The Image Display shall provide measurement tools that allow multiple measurements to be made and remain displayed until the application is closed or the Display Reset tool is applied to one or more selected viewports The Image Display shall provide a tool to measure distance in a straight line between two points within the plane of the image using Pixel Spacing 0028 0030 Imager Pixel Spacing 0018 1164 Nominal Scanned Pixel Spacing 0018 2010 or the Ultrasound Region Calibration Module as appropriate for the SOP Class of the image Distance shall be reported in pixels rather than physical units if there is no spacing
4. 1 2 2012 07 24 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Rev 1 2 2012 07 24 Tool Icon Icon Ref Default Key Action Comments Symbol or Desc State Help IEC 60878 Not Fl or H Pressing this The form and 2003 5289 applicable help button shall encoding of the Application provide access manual need not assistance to a manual be the same as describing the that required for use of the the PDF manual Image Display on PDI media described in RAD TF Vol 1 Section 15 6 4 Advanced Mode Mortarboard Basic mode F10 menu Pressing this Shall be grayed button shall out or absent if change to a there is no different user different user interface interface providing providing advanced advanced functionality functionality The advanced mode shall permit a return to the basic user interface 1110 Table 4 16 4 2 2 5 13 2 Modal Tool Icons Appearance and Action Tool Icon Icon Ref Default Key Action Comments Symbol or Desc State Zoom Magnifying Off Z for Selecting this See 4 16 4 2 2 5 6 O glass zoom tool shall amp change the function of the left or only mouse button when held during mouse movement to change the magnification factor Pan Open hand Off T for Selecting this See 4 16 4 2 2 5 6 translate tool shall change the function of the left or
5. panning and scrolling The user shall be able to unlink synchronization of panning and zooming between viewports pan one and then relink to a new synchronized position e g if the patient has moved between FrameSets within the same nominal DICOM Frame of Reference For images that are not spatially cross referenced the default state shall be unlinked zooming and panning 4 16 4 2 2 5 7 Laterality and Spatial Cross Referencing The Image Display shall display the laterality the side of a paired body part unless unpaired or both parts displayed in the overlaid annotations see 4 16 4 2 2 5 8 and the value shall be obtained from Frame Laterality 0020 9072 Image Laterality 0020 0062 or Laterality 0020 0060 as appropriate for the SOP Class The orientation of the rows and columns as derived from Image Orientation Patient 0020 0037 or if absent explicitly specified in Patient Orientation 0020 0020 shall be annotated on the right and bottom sides of the viewport and may also be annotated on the left and top side and shall account for any rotation or flip applied The Image Display shall provide two means of cross referencing cross sectional slices with the same DICOM Frame of Reference that have not been unlinked or unlinked translated and re linked by the user One means shall be to display localizer lines in which e if multiple viewports are displayed and the slices in the viewports are of orthogonal orie
6. DVD ROM drive Video Integrated Intel GMA X4500HD Graphics Operating System Windows XP Professional SP3 Frameworks NET 2 0 and Java JRE 1 6 installed Display Setting 1280x1024 resolution in 24 bit RGB color Table 15 6 6 2 Basic Viewer Option Performance Reference Image Sets Type Source Contents 19 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR Type Source Contents Large dataset CDFORBIRPERFORMANCE iso study Two spine MR studies for comparison one PET CT study one Chest CT study digital x rays of the chest cervical and thoracic spine and one nuclear medicine Small dataset CDFORBIRPERFSMALL iso One MR spine study from 20070613 Table 15 6 6 3 Basic Viewer Option Performance Benchmarks amp Targets Benchmark Definition Target for Large Dataset Target for Small Dataset Start up to ready to select With auto run disabled time from double clicking the Image Display application icon displayed in the Windows Explorer viewing the root directory of the PDI media any series can be selected for display in a viewport possibly with placeholders for series thumbnails 60 seconds 30 seconds Series thumbnail select to first image of series displayed With the DICOMDIR already read but nothing previously selected the time fro
7. Issues and Questions Issue Question Closed Issues Issue Answer 1 There is no requirement for a DICOM header browser since the profile is for a tool for clinicians not engineers or support staff 2 All basic tool functions are required to be displayed in a toolbar or panel that is visible by default without resorting to drop downs from menus secondary palettes or context sensitive right mouse menus with the exception of the cine tools which may be invoked as a group by a single button 3 Separation of PD and T2 from dual echo SE MR series into separate pseudo series is required Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR Issue Answer 4 Toolbar icons for previous and next image or next frame within a multi frame image are thought to be necessary despite the ability to scroll and cine within a viewport if for no other reason than consistency as well as to provide fine grained control 5 Whether multiple single frame images or a single multi frame image is involved is made transparent to the user for scrolling and forward and reverse navigation 6 A nuclear medicine clamped windowing mode is provided as an alternative tool J A full set of cine functions are required for both multi frame image or multiple images in a series ful
8. Supplement Basic Image Review BIR e High Bit 0028 0102 of one less than Bits Stored 0028 0101 i e in the low bits of the word without packing e Samples Per Pixel 0028 0002 of 1 or 3 e Photometric Interpretation 0028 0004 of MONOCHROME1 MONOCHROME2 RGB PALETTE COLOR and any appropriate value for any multi component compressed transfer syntaxes that are supported e s YBR FULL 422 for JPEG e Planar Configuration 0028 0006 of 0 or 1 for RGB Photometric Interpretation 0028 0004 i e color by pixel or color by plane e Pixel Representation 0028 0103 of 0 or 1 for MONOCHROME and MONOCHROME2 Photometric Interpretation 0028 0004 i e signed or unsigned e Number of Frames 0028 0008 absent or with any value i e single or multi frame images Amend Section 4 16 4 2 4 16 4 2 View Images This transaction relates to the View Images event of the above interaction diagram 4 16 4 2 1 Trigger Events The Image Display or Imaging Document Consumer is requested to be eapablete display the images 4 16 4 2 2 Invocation Semantics This is a local invocation of functions at the Image Display or Imaging Document Consumer 4 16 4 2 2 1 Display of Digital X Ray Mammo and Intra Oral Images For the For Presentation variant of the Digital X Ray Image the Digital Mammography Image and the Digital Intra oral X Ray Image the Image Display or Imaging Document Consumer actor shall have bo
9. THE Radiology Technical Framework Supplement Basic Image Review BIR Encryption of data and other access controls to media content are not addressed in this profile Media created using this profile should be considered to be unlocked information e g like paper records Such media should be handled according to appropriate site policies e g do not give a patient a disk containing data from other patients do not leave disks where they can be taken by unauthorized persons etc For many Use Cases it is not appropriate to place data from multiple patients on a single media for Security and Privacy Reasons 15 6 Basic Viewer Option A Portable Media Creator that claims the Basic Viewer Option shall be able to include a viewer on the media That viewer shall support the display requirements of the Retrieve Images RAD 16 of the Basic Image Review Profile as an Image Display Actor The viewer is not required to support the Query Images RAD 14 transaction Additional requirements beyond the Basic Image Review Profile are required by the Basic Viewer Option They are appropriate for the Physician Viewing use case in Section 15 3 1 particularly when the receiving user has no pre existing relationship with the sender is unfamiliar with any viewer included on the media has no pre installed local Image Display and has little control over a relatively basic hardware and software environment The requirements for the support of SOP I
10. a double click will be displayed in the currently open viewports or newly opened viewports see also Layout e SHIFT click contiguous thumbnails to allow selection of two or optionally more FrameSets which after a double click will be displayed in the currently open 770 viewports or newly opened viewports see also Layout The Image Display shall not permit the user to select more FrameSets than can be displayed in viewports Other mechanisms such as drag and drop may be provided at the implementer s discretion 775 In addition to the thumbnail navigation specific toolbar icons shall be provided for e revious and next stud e revious and next FrameSet e revious and next image or frame within a FrameSet that apply to the currently selected viewport see 4 16 4 2 2 5 13 780 For the specific case of dual echo MR images in which slices of different acquisition contrast PD and T2 may be interleaved within the same FrameSet the slices shall be separated by Echo Number 0018 0086 into two separate FrameSets for the purpose of showing them as separate thumbnails selecting them for display and displaying them in a viewport 785 Within a displayed FrameSet cross sectional slices shall be sorted by anatomical spatial position then for each spatial position by time of acquisition and other slices shall be sorted by Instance Number or sequential frame order 4 16 4 2 2 5 4 Windowing and Rendering The default when grayscale imag
11. current slice that is 35 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 870 875 880 885 890 895 900 IHE Radiology Technical Framework Supplement Basic Image Review BIR e scroll towards the patient s head for transverse images viewed from inferiorly e scroll towards the patient s posterior for coronal images viewed from anteriorly e scroll towards the patient s right for sagittal images viewed from the left Vertical movement of the mouse upwards for other images shall e scroll towards earlier frames of a multi frame images e scroll towards lower Instance Numbers in a series of single frame images For cross sectional images in the same DICOM Frame of Reference as the images in the currently selected viewport scrolling shall be synchronized between viewports based on three dimensional location unless unlinked Note that this means that if the slice intervals are different in different FrameSets in the same plane the scrolling may not appear to be at a uniform rate in different viewports Interpolation between slices is not required by this profile but may be included at the implementer s discretion If the end of one FrameSet is reached during scrolling and another linked FrameSet has more slices scrolling shall continue and the viewport displaying the exhausted FrameSet shall be shown as black Scrolling shall not loop around to the first slice at the end of the FrameSet Synchr
12. data is not specified by this profile such data shall be placed in a separate directory on the media If such data is referenced in the INDEX HTM file it shall be clearly indicated that this content was not generated in conformance with the IHE Radiology Technical Framework and its reliable import has not been addressed 15 5 Security and Privacy Aspects Portable Media Creator actors shall ensure that no malicious software viruses etc is present on created media The automatic oe o See foni media poses a risk that malicious software could be started and eadine DES R oY op nehine eal Despite these sien many recipients prefer the convenience Se tot run It is the site s or operating system s responsibility to suppress auto run if required Furthermore if a DICOM media viewer is present security issues are minimized by e working under normal restricted user privileges and not requiring the user to work with administrator or root privileges and e not needing software installed on the computer where the media is used Audit trails to track export import viewing activities are addressed in ITI TF 2 3 20 and RAD TF 3 5 1 Portable Media Creator and media reading actors that claim support of the Audit Trail and Node Authentication Integration Profile shall generate such audit trail entries 14 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 305 310 315 320 325 330 335
13. described in 4 16 4 2 2 5 13 e optionally a tool to trigger a change in layout to advanced functionality For studies that contain multiple FrameSets that are not spatially correlated the default 690 shall be display of a single FrameSet in a single viewport For studies that contain multiple FrameSets of spatially correlated information e g multiple transverse MR FrameSets the default shall be display of two FrameSets in side by side viewports If the FrameSets share the same DICOM Frame of Reference UID the viewports shall by default 695 e besynchronized with respect to scrolling see 4 16 4 2 2 5 5 Scrollin e be synchronized with respect to panning and zooming see 4 16 4 2 2 5 6 Zoomin and Panning e have cross referencing active see 4 16 4 2 2 5 7 Laterality and Spatial Cross Referencing 700 Which two spatially correlated FrameSets to choose for the default is at the discretion of the implementer A Layout Multiple Viewports tool shall be provided to allow the user to select the number and arrangement of the viewports At least two layouts shall be supported e a single viewport and 705 e two vertical viewports side by side A Layout Within Viewport tool shall be provided to allow the user to select the number and arrangement of image tiles within each viewport At least four layouts shall be supported e a single tile e two vertical tiles side by side 710 e two horizontal tiles one above the other and
14. e four tiles in a grid The Layout Within Viewport tool shall be inactive if the selected viewport contains a FrameSet that has only one frame i e multi frame image that has only one frame or series of single frame images that have only one image 715 The Image Display shall provide tools to rotate images with a Modality 0008 0060 of DX or CR displayed in the selected viewport by 90 degree increments and to flip them horizontally These tools shall be inactive for other modalities for safety reasons 31 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 720 725 730 735 740 745 750 755 THE Radiology Technical Framework Supplement Basic Image Review BIR 4 16 4 2 2 5 3 Navigation The Image Display shall provide a means of selecting the single patient to display for contexts in which a selection needs to be made between different patients for display e g when the Image Display is communicating with an Image Archive For contexts in which only one patient is available e g when the Image Display is executed from PDI media on which data for only a single patient is recorded there is no need for a patient selection mechanism The Image Display shall not display FrameSets for multiple patients simultaneously Only images with exactly the same value for Patient s ID 0010 0020 and Patient s Name 0010 0010 shall be displayed at the same time other Patient level attri
15. l l Retrieve Images C MOVE 25 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 545 550 555 560 IHE Radiology Technical Framework Supplement Basic Image Review BIR Image Display Access Images see Note 1 View Images Note 1 Access to images may be through some means other than a network activity when the Image Display actor is grouped with another actor e g Portable Media Importer or has access through some other means e g if the Image Display is encoded on media by the Portable Media Creator supporting the Basic Viewer Option in the Portable Data for Imaging profile Amend section 4 16 to add Basic Image Review Profile to the Retrieve Images Transaction 4 16 4 1 3 3 Basic Image Review Profile 4 16 4 1 3 3 1 Basic Image Review Profile SOP Class Support The following sub sections define two levels of support for Image Display actors e full support which includes all of the requirements described in 4 16 4 2 2 5 e partial display only support which requires any single or multi frame image regardless of SOP Class e to be rendered in a viewport scrolled windowed panned and zoomed e but excludes spatial location acquisition timing and technique annotation localization measurement and cross referencing 4 16 4 1 3 3 1 1 SOP Class Support for PDI Media A PDI Portable Media Creator that supports the Basic Viewer option shall include an Image Display
16. on their own equipment either of which may be an Image Display implementing the Basic mage Review w Profile or BS a We Oe Fhis just be informative data For EE and Da reasons Ge given Ss a ou hot contain data of other patients Refer to section 15 5 for additional security considerations 11 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 195 200 205 210 215 220 225 IHE Radiology Technical Framework Supplement Basic Image Review BIR Use Case 2 Healthcare Enterprise Interchange One or more patients data such as images reports or complete studies is received on media to enable a diagnostic or therapeutic care process Media data are imported at a different site generally for the purpose of a second read import or reference import e Second Read Import Media data is imported to the Image Manager Archive to be read over read In order to avoid data conflicts key patient study attributes may need to be reconciled with existing local data Images and related presentation states can be sent to a Print Composer to be printed e Reference Import Media data is imported to the Image Manager Archive and or Report Repository to become part of the patient history It may be used as relevant prior data for future reads In order to avoid data conflicts key patient study attributes may need to be reconciled with existing local data Use Case 3 Operating Room View
17. only mouse button when held during mouse movement to cause the image to move with respect to the 49 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR viewport Window IEC 60878 2003 5435 Brightness Contrast Off W for window Selecting this tool shall change the function of the left or only mouse button when held during mouse movement to adjust the windowing parameters See 4 16 4 2 2 5 4 Shall be grayed out for color images Scroll Stack of boxes representing frames S for scroll Selecting this tool shall change the function of the left or only mouse button when held during mouse movement to cause the frame displayed in the viewport to be scrolled to an earlier or later frame See 4 16 4 2 2 5 5 Select Viewport Arrow facing upwards and to the left Off V for viewport Pressing this button shall cause the viewport in which the cursor is placed when the left mouse button is next clicked to become the selected viewport to which subsequent operations shall apply Multiple viewports may be selected see 4 16 4 2 2 5 11 Distance Measurement Based on IEC 60878 2003 5658 Distance Measurement Off D for distance Selecting this tool shall change the function of the left or only
18. or calibration information in the image otherwise the distance shall be reported in the units of the DICOM attribute used mm in the case of pixel spacing attributes and whatever units are specified for the Ultrasound Region The precision of the measurement shall be one displayed pixel at the magnification factor applied to the image when the end points are placed by the user i e the distance shall be measured with sub image pixel resolution There is no requirement to attempt to account for geometric magnification in projection radiographs The pixel spacing attributes account for non square pixels since the DICOM attributes define separate row and column spacing values and this shall be accounted for in diagonal measurements The Image Display shall provide a tool to measure the angle between two straight line segments which do not necessarily share a common vertex This allows Cobb angle to be measured rather than a three point angle tool with a common vertex required The angle shall be reported in degrees At all times except during cine the scaled pixel value physical unit corresponding to the current cursor location shall be reported to the user e g in the status bar For example the Hounsfield Unit value of a CT voxel or the SUV g l value of a PET voxel would be displayed The appropriate scale factors are SOP Class specific Additional information such as the 3D voxel location may also be displayed but is not req
19. other information whether via the Internet or local area network These requirements are not intended to discourage the presence of applications that support multiple platforms either in a single application or through the presence of multiple applications Nor are they intended to endorse the suitability of any hardware or software platform for this purpose only to recognize what is realistic to maximize the probability that a user will be able to use the viewer on the media If a pre installed framework is present the application may use it to improve performance Similarly accelerated graphics performance more memory and more processors or cores can be used if available but the application is required to be able to work without them The application is required to take advantage of the size of the primary monitor i e if the display is larger than the minimum 1024x768 requirement then the large size should be used rather than displaying a fixed 1024x768 size window The application shall tolerate the presence of multiple monitors of different resolutions though it is not required to be able to make use of multiple monitors It is recommended though not required that the application be usable with both portrait and landscape monitors in addition to both grayscale and color monitors The option does not require that the application provides a means of calibration to the DICOM GSDFE as required in the CPI Profile but does not
20. preclude providing such a capability from within the application or providing or taking advantage of an external means of calibration The option requires the application to support single button pointing devices but does not preclude it from taking advantage of multiple buttons if present including a middle scroll wheel If a middle scroll wheel is present then it is required to be supported by the application at least for the purpose of scrolling between multiple slices of cross sectional images The ability to display reports present on the media shall not depend on any additional pre installed software beyond any capabilities present in the operating system requirements such as a PDF viewer or specific fonts 15 6 2 Security and Persistence Requirements The Basic Viewer Option does not require that the Image Display included on the media support the ATNA Profile but it is not precluded from doing so The Basic Viewer Option requires that the Image Display automatically launches if permitted by the operating system site configuration and not disabled by the user 16 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 380 385 390 395 400 405 410 THE Radiology Technical Framework Supplement Basic Image Review BIR If the Web Content Option is also supported then the INDEX HTM file shall contain a link that executes the viewer see RAD TF Vol 2 Section 4 47 4 1 2 2 2 The Bas
21. 1 128 Positron Emission Tomography Image Storage 1 2 840 10008 5 1 4 1 1 7 Secondary Capture Image Storage 1 2 840 10008 5 1 4 1 1 6 1 Ultrasound Image Storage 1 2 840 10008 5 1 4 1 1 3 1 Ultrasound Multi frame Image Storage 1 2 840 10008 5 1 4 1 1 12 1 X Ray Angiographic Image Storage 1 2 840 10008 5 1 4 1 1 12 2 X Ray Radiofluoroscopic Image Storage There is no explicit requirement to provide full support for other DICOM SOP Classes since at this time these are either thought to be beyond the capability of basic image review e g the Enhanced family of objects or are specifically addressed by other profiles e g mammography or are outside the domain of radiolo e g visible light in general ophthalmology slide microsco dentistry An Image Display actor supporting the Basic Image Review Profile that has not been included on PDI media i e without the Basic Viewer Option shall provide partial display only support for all SOP Classes not specified in Table 4 16 4 1 3 3 1 that have the following characteristics e Pixel Data 7FE0 0010 data element present e Bits Allocated 0028 0100 of 8 or 16 e Bits Stored 0028 0101 values of 1 or 8 for Bits Allocated 0028 0100 of 8 e Bits Stored 0028 0101 values of 9 to 16 inclusive for Bits Allocated 0028 0100 of 16 27 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 585 590 595 600 605 610 615 IHE Radiology Technical Framework
22. 905 910 915 920 925 930 935 940 THE Radiology Technical Framework Supplement Basic Image Review BIR Vertical movement of the mouse upwards shall decrease the magnification factor i e zoom out and downwards shall increase the magnification factor i e zoom in Horizontal movement of the mouse when this tool is selected shall have no effect A separate Pan tool shall be provided to select panning within the selected viewport with the left or only mouse button held down left or right or up or down or diagonally in the direction of the mouse movement Interpolation for display shall be continuous e g linear or bicubic and not by nearest neighbor replication Both magnification and minification shall be supported Zooming shall be synchronized across all spatially cross referenced images even if they are in different orientations Panning shall be synchronized across all spatially cross referenced images in the same orientation The initial state when the image is loaded or the display reset shall be to scale the image size of the first series to fit its viewport size without distortion of the pixel aspect ratio For cross sectional images in the same DICOM Frame of Reference displayed in other viewports the same center three dimensional location and magnification as the first viewport shall be applied this provides an appropriate initial state for subsequent synchronized zooming
23. AGING INTEGRATION PROFILE OPTIONS sisi 10 15 3 PORTABLE DATA FOR IMAGING PROCESS FLOW esse 11 15 3 1 eege egen tactile Meter Lies ee Montes Sa bows Ji eege tege Mach bial he eege 11 15 3 2 Ee EE 12 15 4 MEDIA CONTENT WEE 13 15 4 1 DIC OMEC ONCE ieee ca tes cote EENEG 14 15 4 3 Other EE 14 15 5 SECURITY AND PRIVACY ASPECTS cccsccccssssececsescececsececeesaececeeseeeeesueeecnesaesecseeeseesueeecsesaesecseeeeeesaeeecnsgas 14 15 6 BASIC VIEWER OPTION eener soci tos ndlr net Seeds de dB de dada en ee E RSR dada eee sub das eds sdeeads 15 15 6 1 Platform Hardware and Software Requirements ss 15 15 6 2 Security and Persistence Requirements iii 16 15 6 3 STEE 17 15 6 4 Usability Reg irements zipio nonii nane EE e 17 15 6 5 Performance Reguiremente ss 18 26 BASIC IMAGE REVIEW INTEGRATION PROFILE sccccccccssssssssscccsssssssessccccessscseccsesssssscescscescsseseoseree 22 26 1 ACTORS TRANSACTIONS EE 22 26 2 BASIC IMAGE REVIEW INTEGRATION PROFILE OPTIONS ccccccesssscecesssececsesceceessececseaeeecseseeeeeaeeecseaeeecseaeess 23 26 3 BASIC IMAGE REVIEW PROCESS FLOW c ccccsssssesesssscecssseeeecnececesaeeecessaeeecseeeeesesaeeecsesaeeecsaeeesesueeecsesaeeeseeaaess 24 VOLUME 2 TRANSACTIONS isscctssssccnacscscsuscs soscos zeceosagseccesisccuseasvonsesbiseodssueasaebedus cossacsseyooksdeasuesesbaseasessoscsasseete 25 4104 Interaction Diagramme ent tn EE ENG atte A es ane de neue es 25 APPENDIX F ORGANIZATION OF SERIES AND IMAGES INT
24. I profile that supports the Basic Viewer Option and includes a Basic Image Review Image Display Actor on the PDI media 26 2 Basic Image Review Integration Profile Options Options that may be selected for this Integration Profile are listed in the Table 26 2 1 along with the Actors to which they apply Dependencies between options when applicable are specified in notes Table 26 2 1 Basic Image Review Actors and Options Actor Options Vol amp Section Image Archive Manager No options defined Image Display No options defined 23 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR 26 3 Basic Image Review Process Flow Image Manager Image Display Image Archive Read Media Present Images to User or Query Images 14 Retrieve Images 16 Present Images to User 530 Figure 26 3 1 Basic Process Flow in Basic Image Review Profile 535 24 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR Volume 2 Transactions Amend section 4 16 4 Interaction Diagram to include non network transaction 4 16 4 Interaction Diagram Image Archive Image Display Retrieve Images C MOVE Store Images C STORE View Images 540 Imaging Imaging Document Document Source Consumer l I I
25. Integrating the Healthcare Enterprise 5 IHE Radiology Technical Framework Supplement 10 Basic Image Review BIR Trial Implementation 15 20 Date July 24 2012 Author IHE Radiology Technical Committee 25 Email radiology ihe net Copyright 2012 IHE International Inc 30 35 40 45 50 THE Radiology Technical Framework Supplement Basic Image Review BIR Foreword This is a supplement to the IHE Radiology Technical Framework V11 0 Each supplement undergoes a process of public comment and trial implementation before being incorporated into the volumes of the Technical Frameworks This supplement is published for Trial Implementation on July 24 2012 and may be available for testing at subsequent IHE Connectathons The supplement may be amended based on the results of testing Following successful testing it will be incorporated into the Radiology Technical Framework Comments are invited and may be submitted at http www ihe net radiology radiologycomments cfm This supplement describes changes to the existing technical framework documents and where indicated amends text by addition bold underline or removal beld strikethreugh as well as addition of large new sections introduced by editor s instructions to add new text or similar which for readability are not bolded or underlined Boxed instructions like the sample below indicate to the Volume Editor how to integrate the relevant sectio
26. O FRAME SETS ccssssccsssseceesseeeees 53 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 90 95 100 105 IHE Radiology Technical Framework Supplement Basic Image Review BIR Introduction Profile Abstract It is common practice for imaging facilities to distribute images on CDs and for receiving physicians to review those images using a viewer included on the CD Physicians have increasingly expressed frustration that frequently e viewers do not run successfully e viewers do not load the images successfully e the viewer loads too slowly e the viewer claims to be not of diagnostic quality e functions critical to review are missing from the viewer e the various viewers encountered on CDs have unique graphical user interfaces that do not provide obvious access to basic functions The impact is delayed care inaccessible information repeat examination and irradiation and poor use of valuable clinician time Creators of CDs may be unaware of the problems encountered by the physicians receiving the CDs and thus critical feedback about these issues is not communicated to the vendor of the system Working closely with representatives of the American Medical Association and the American Association of Neurological Surgeons the IHE Radiology Technical Committee has developed this profile to define the appropriate baseline functionality and behaviors for image viewing software on CD Open
27. Pressing this button shall present a drop down of selected grid sizes for multiple viewports See 4 16 4 2 2 5 2 See 4 16 4 2 2 5 2 Invert Grayscale IEC 60878 2003 5411 Reversal black to white Not inverted No default shortcut Clicking this button shall toggle the inversion state See 4 16 4 2 2 5 4 Rev 1 2 2012 07 24 45 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Tool Icon Icon Ref Default Key Action Comments Symbol or Desc State Localizer lines Person in a Off O for Selecting this See 4 16 4 2 2 5 7 box image overlay tool shall toggle Shall be grayed with a single the display of aut this Sege dotted localization displayed on overlaid lines on or off which to show transverse line localizer lines Link unlink translation Three links in Linked if L for link Pressing this See 4 16 4 2 2 5 5 synchronization a horizontal same and U for button shall Shall be grayed chain DICOM unlink toggle the outitno Series are Three linksin Frame of synchronization available to link 3 Reference of the currently a horizontal i chain with th unlinked if selected middle link different viewports from visibly broken DICOM participating in open Frame of synchronization Reference of navigation scrolling and zoomi
28. Report tool to display all content on the media that was identifiable by the Portable Media Creator as a report related to the DICOM images on the media Notes _1 There is no requirement that such reports be in a standard format as long as the viewer can display 1075 them It is expected that the Portable Media Creator might use DICOM Structured Reports DICOM encapsulated PDF documents DICOM encapsulated CDA documents unencapsulated CDA documents encoded using ITI XDM profile CDA encapsulated PDF documents encoded using ITI XDS Scanned Document XDS SD profile but this is entirely at the discretion of the Portable Media Creator 2 Some content on the media e g reports scanned as DICOM Secondary Capture images may not be 1080 clearly identifiable to the Portable Media Creator as reports but would be displayed as ordinary images 3 All of the reports on the media are displayed regardless of whether the series to which they apply is currently displayed or not since the reports may be in an unstructured format without meta data to allow the application to determine to which series they apply 4 16 4 2 2 5 13 Tool Icons and Actions 1085 The icon symbols described in this section are not intended to be used exactly with the bitmap illustrated but rather used as a guide to build the implementers own icons as long as they are recognizable as being the same symbol Some icons may require variants to indicate that it is in the activate
29. a content can be accessed via two entry points on the media the DICOMDIR file for DICOM imaging information and optionally the INDEX HTM file for web viewable content Created media are required to contain DICOM data and may optionally include web viewable 13 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 270 275 280 285 290 295 300 IHE Radiology Technical Framework Supplement Basic Image Review BIR data derived from it This web viewable data if present shall faithfully preserve the clinical intent of the original DICOM information 15 4 1 DICOM Content The DICOM data shall be created by using the DICOM General Purpose Media Storage Application Profile The DICOMDIR file shall reference all DICOM files stored on the media DICOM files shall not be placed in the root directory but no constraints are placed on the name of directory that contains them 15 4 3 Other Content Viewing applications for example a DICOM Media Viewer may optionally be included on the media Such viewers may conform to the Basic Image Review Integration Profile Basic Viewer Option Such viewers may have launch links included in the HTML inehiding such eversenfhe medias diseoticed tire to secHeih_isstes_ discussed tithe Hest se CHO Es wrellas_petential diicreperabiit prebloms Additional data e g a diagnostic report in non DICOM format may be also included on the media Since the format of any such
30. actor on the PDI media that provides full support for all of the DICOM SOP Classes of all Images included on the PDI media It is not required to provide any support for other DICOM SOP Classes 26 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 565 570 575 580 THE Radiology Technical Framework Supplement Basic Image Review BIR 4 16 4 1 3 3 1 2 SOP Class Support other than for PDI Media An Image Display actor supporting the Basic Image Review Profile that has not been included on PDI media i e without the Basic Viewer Option shall provide full support for all the SOP Classes specified in Table 4 16 4 1 3 3 1 Table 4 16 4 1 3 3 1 SOP Classes for Basic Image Review Profile SOP Class UID SOP Class Name 1 2 840 10008 5 1 4 1 1 1 Computed Radiography Image Storage 1 2 840 10008 5 1 4 1 1 2 CT Image Storage 1 2 840 10008 5 1 4 1 1 1 1 Digital X Ray Image Storage For Presentation 1 2 840 10008 5 1 4 1 1 4 MR Image Storage 1 2 840 10008 5 1 4 1 1 7 2 Multi frame Grayscale Byte Secondary Capture Image Storage 1 2 840 10008 5 1 4 1 1 7 3 Multi frame Grayscale Word Secondary Capture Image Storage 1 2 840 10008 5 1 4 1 1 7 1 Multi frame Single Bit Secondary Capture Image Storage 1 2 840 10008 5 1 4 1 1 7 4 Multi frame True Color Secondary Capture Image Storage 1 2 840 10008 5 1 4 1 1 20 Nuclear Medicine Image Storage 1 2 840 10008 5 1 4 1
31. ade printers viewports one through the or more to be ordinary operating printed using system printer the operating drivers not system printer DICOM printers with the current and not for windowed producing appearance diagnostic quality scroll position prints zoom and pan state and annotation state including both the corner annotations and any measurement tools that have been applied Display Reset IEC 60878 Not Escape Pressing this The scroll 2003 5495 applicable button shall position shall not Return to an reset the change when this initial state selected button is pressed viewports to their default zoom and pan state fit image to viewport without any rotation or flip the window values to the initial default and will remove any measurements that have been made Show Report Lines of text Not R for Pressing this See in two displayed report button shall 4 16 4 2 2 5 12 paragraphs cause all the Shall be grayed rep ons out if no next available for the reports available current patient to be displayed 47 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Tool Icon Icon Ref Default Key Action Comments Symbol or Desc State Rotate 90 degrees IEC 60878 Not rotated No default Pressing this See 4 16 4 2 2 5 2 clockwise Came 2003 5772 shortcut button sh
32. al Inc 230 235 240 245 250 255 260 265 IHE Radiology Technical Framework Supplement Basic Image Review BIR Any web viewable media content is received and displayed by a Display actor which exists as a generally available resource i e web browser Note that the Portable Media Creator cannot rely on the presence of web viewable content on all media since it will be included only on media created using the Web Content Option B2 DICOM Use Case 1 and 3 users with DICOM viewing equipment or software or media created with the Basic Viewer Option The DICOM portion of the media content is displayed using specialized applications pre existing in the reading environment or included on the media itself The variety of DICOM objects that an Image Display and or Report Reader actor can process is indicated by its support of the corresponding content profiles The Print Composer actor sends images from the media to a Print Server for printing C Media Import Use Case 2 The Media Import activity is accomplished by a Portable Media Importer and deals exclusively with the DICOM portion of the media content The Portable Media Importer actor is grouped with one or more content actors Evidence Creator Report Creator etc depending on the type of media content to be imported The grouped actor provides storage capability for the media data accessed by the Portable Media Importer The Portable Media Imp
33. all play forwards at a normal rate Pressing this button shall stop cine and return to display of the first frame Cine Pause Off No default shortcut Pressing this button shall pause cine at the currently displayed frame Rev 1 2 2012 07 24 51 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Tool Icon Icon Ref Default Key Action Comments Symbol or Desc State Cine Go to Start Off No default Pressing this shortcut button shall go to the first frame and pause Cine Step IEC 60878 Off No default Pressing this 2003 5471 shortcut button shall Frame by step one frame frame forwards general Cine Go to End Off No default Pressing this shortcut button shall go to the last frame and pause 1115 1120 1125 1130 1135 4 16 4 2 3 Expected Actions The Image Display or Imaging Document Consumer presents to the user a DICOM Image The Image Display or Imaging Document Consumer may receive patient data inconsistent with those received from a previously issued query or retrieve operation For example in the event that a patient has been renamed the Image Display or Imaging Document Consumer will receive images with the same Study Instance UID Series Instance UID and SOP Instance UIDs but with a different patient name The Image Display or Imaging D
34. all E button R Rotation gt Reie the presses will rotate modified to be displayed a further 90 single image 90 degrees direction degrees clockwise Shall be grayed out if not applicable to type of image Flip Horizontally IEC 60878 Not flipped No default Pressing this See 4 16 4 2 2 5 2 2003 5408 shortcut button shall flip second button Reversal the displayed presses will flip right to left E the image back to horizontally its previous state i e about the vertical display Shall be grayed axis out if not applicable to type of image Cine Tools IEC 60878 Not C for cine Pressing this Shall be grayed 2003 1123 available button will out if FrameSet Cine make available contains only one radiographic the cine frame exposure controls Other navigation tools shall be grayed out when in cine mode Window Presets IEC 60878 Defaults to No default Pressing this Amongst the 2003 5435 first setting shortcut button shall defaults shall be a icon with a encoded in present a drop choice for dropdown the image down of whatever settings decoration or auto if window presets are encoded in the none which when the image which may user makes a be multiple and choice shall a default apply to all computed from selected the properties of viewports the pixels auto Additionally for CT presets for soft tissue bone lung and brain shall be provided at minimum Shall be grayed out for color images 48 Rev
35. ase of all Multi Frame Images Within Separate Series Example Enhanced CT Series amp Image amp Comment of SOP FrameSet Frame Next Prior Cine Description Frames Class Identifier Series 1 Localizer Image 1 AP 1 CT MF FrameSet 1 1 1 gt None No Series 2 Lung Image 1 Lung 140 CT MF FrameSet 2 1 1 gt lt lt Yes gt lt 140 gt gt lt Series 3 Bone Image 1 Bone 140 CT MF FrameSet 3 1 1 lt lt Yes gt lt 140 gt gt lt Table F 1 4 Simple Case of all Multi Frame Images Within Single Series Example Enhanced CT Series amp Image amp Comment of SOP FrameSet Frame Next Prior Cine Description Frames Class Identifier 56 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Series A Image amp Comment of SOP FrameSet Frame Next Prior Cine Description Frames Class Identifier Series 1 Image 1 AP 1 CT MF FrameSet 1 1 1 gt None No Image 2 Lung 140 CT MF FrameSet 1 2 1 gt lt lt Yes gt lt 140 gt gt lt Image 3 Bone 140 CT MF FrameSet 1 3 1 gt lt lt Yes gt lt 140 gt gt lt 57 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc
36. butes may be different empty or absent Though it is possible that the same patient may have slightly different identifying attributes in different DICOM images performed at different sites or on different occasions it is expected that such differences will have been reconciled prior to the images being provided to the Image Display e g in the Image Manager Archive or b the Portable Media Creator The Image Display may provide some means of selecting manually or automatically based on similarity rules a sub set of studies for which to provide FrameSet thumbnails when multiple studies are available for the same patient otherwise thumbnails shall be provided for all FrameSets The Image Display shall allow at least two FrameSets for the same or different studies to be compared side by side in separate viewports to allow for comparison of different modalities or current or prior studies The Image Display shall allow display of only a single FrameSet in a single viewport in order to take advantage of limited screen space and a single FrameSet in two viewports in order to view them with different window levels The Image Display shall provide thumbnails for each FrameSet for the purpose of providing a Gestalt overview of all FrameSets available for all studies for the same patient and allowing the user to select navigate to a particular FrameSet for display These thumbnails shall e be of sufficient size to be recog
37. can be achieved or surpassed The reference platform is intended to represent a typical contemporary platform and to meet reasonable expectations as distinct from the minimum requirements specified in 15 6 1 which are intended to enable access in a worst case environment with potentially degraded performance The following test conditions are defined e targets are defined in seconds between action initiation and desired response e performance times are measured by repeating each test and shall meet the target in at least 3 out of every 4 invocations of the test e caches are to be cleared between invocations of tests e s by rebooting to prevent intermediate cached data rather than data retrieved from media being used e targets assume that the media in the drive is spinning many drives spin down after a period of inactivity an additional 5 seconds may be added to the target times if a delay for the media to spin up is unavoidable since this may be beyond the viewer s control The reference image sets may be found at http wiki ihe net index php title Basic Image Review Implementation Sample Data Table 15 6 6 1 Basic Viewer Option Performance Reference Platform Component Specification Processor One Intel Core 2 Duo 2 33 GHz single processor dual core with 4MB Level 2 cache 1333FSB RAM 2 GB DDR2 800MHz SDRAM Hard drive 500 GB 7200 RPM SATA Hard Drive CD drive Half height 5 25 48X CD read
38. cation starts e it shall provide the user with the option of immediately terminating e g to allow a pre installed already executing viewer to be used instead e it shall provide immediate feedback to the user when it is invoked e g through a dialog box or splash screen or appropriate cursor change when they double click the application icon e it shall terminate with a clear and unambiguous error message to the user if the hardware or software requirements of the platform are insufficient to execute e it shall provide a display or listing of the media contents patients studies and series to the user automatically without requiring any further user initiated action since the goal is to be able to view the contents of the media not images from other sources Only one instance of the application shall be executing at any one time and the application shall be robust in the face of attempts by the user to execute multiple copies e g if they double click the application icon multiple times in frustration whilst waiting for the first invocation to actually run The user shall have the ability to close the application using the ordinary window decoration icon for this purpose typically an iconic X in the top right of the window The application shall be closable even if the media has been physically removed The viewer may close if the media is physically removed If the viewer does not terminate there is no requi
39. d pressed state and these are not explicitly shown here since it is up to the implementer s look and feel to provide a consistent pattern for this 41 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 1090 1095 1100 1105 THE Radiology Technical Framework Supplement Basic Image Review BIR There are various classes of tools e those that trigger an immediate action Action Tools described in Table 4 16 4 2 2 5 13 1 e those that change the function of the left or only mouse button and are related to the position of the pointing device and cursor Modal Tools described in Table 4 16 4 2 2 5 13 2 e those that control cine Cine Tools described in Table 4 16 4 2 2 5 13 3 The Modal Tools that affect the function of the left or only mouse are mutually exclusive the tool icons shall change appearance to indicate that they are selected the cursor shall also change to convey to the user that the mode is active and a cursor shape shall be used that is recognizably similar to the icon used to select the tool All tool icons shall supply a tool tip that appears when the cursor dwells over the icon which shall describe a the function of the tool and b the keyboard shortcut for the tool if any Any operating system on the Image Display provides Key Repeat functionality While this operating system feature may be useful for Previous Next Study Series Image Frame the Image Display is not re
40. dalities but it is beyond the scope of IHE to define these Annotations that are common to all viewports or tiles need not be displayed in every viewport or tile The Image Display shall provide a tool to suppress the display of the annotations and to minimize the annotations to just display patient s name and date of study 4 16 4 2 2 5 9 Cine The purpose of the cine function is to allow a means of displaying a FrameSet that is a continuous temporal display in addition to not instead of scrolling and stepping back and forth between individual frames This is typically used as the primary means of displaying FrameSets that were acquired with a dimension of time in the first place eo cardiac angiograms and echocardiography ultrasound but is not confined to this use The Image Display shall provide a cine function for the currently selected FrameSet i e multi frame image or currently selected series of single frame images of the same size i e the same values for Rows and Columns which allows the user to e play the frames as a continuously cycling loop either forward or reverse e stop pause step one frame skip to first frame and skip to last frame The Image Display shall provide an ability to control the frame rate frames displayed per second The default shall be the frame rate specified in the DICOM attributes if present 39 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 1015 1020
41. ded images or an application that degrades them for display It is recommended though not required that the application also not irritate the user with notices with respect to whether or not the user has the patient s permission to view the images nor require that the user agree to any terms or conditions or license as a pre requisite for viewing the patient s images The suitability of any viewer that complies with the Basic Image Review Profile for clinical or diagnostic use may be subject to local regulation or policy which is beyond the scope of IHE to define 15 6 4 Usability Requirements The application shall automatically run when the media is inserted unless the configuration of the machine has been specifically set up to prevent it or the user holds the SHIFT key down when inserting the media I e there shall be an AUTORUN INF file present in the root directory that executes the viewer The Basic Viewer Option requires that it shall be possible to manually start the Image Display application by clicking on a file in the root directory named VIEWER BAT or VIEWER EXE 17 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 415 420 425 430 435 440 445 450 THE Radiology Technical Framework Supplement Basic Image Review BIR If the media contains multiple viewers the initially launched application shall allow the user to select which viewer to use When the appli
42. e DICOM encoded objects 15 2 Portable Data for Imaging Integration Profile Options Options that may be selected for this Integration Profile are listed in table 15 2 1 along with the Actors to which they apply Dependencies between options when applicable are specified in notes Table 15 2 1 Portable Data for Imaging Actors and Options Actor Options Vol amp Section Portable Media Creator Web Content RAD TF 1 15 4 2 RAD TF 2 4 47 4 1 2 Basic Viewer RAD TF 1 15 6 RAD TF 2 4 47 4 1 2 2 3 1 RAD TF 2 4 47 4 1 2 2 4 Portable Media Importer No options defined Image Display No options defined Report Reader No options defined Print Composer No options defined 10 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 160 165 170 175 180 185 190 IHE Radiology Technical Framework Supplement Basic Image Review BIR Actor Options Vol amp Section Display ITI TF No options defined 15 3 Portable Data for Imaging Process Flow This section describes the typical process flow related to the use of Interchange Media The transaction covered is 47 Distribute Imaging Information on Media The following steps can be identified in this process flow The source actor Portable Media Creator writes a group of image dataset s and or the associated diagnostic report s onto a piece of interchange media Itis presumed that the Portable Media Crea
43. es are displayed in a viewport shall be to use the first set 790 of VOI LUT or window values supplied in the DICOM attributes If VOI LUT or window values are absent either a default based on statistical analysis of pixel values or a modality specific appropriate preset such as soft tissue preset for CT images shall be used 33 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 795 800 805 810 815 820 825 830 THE Radiology Technical Framework Supplement Basic Image Review BIR For grayscale images a tool shall be provided to select the use of the mouse to window the images in all tiles of the currently selected viewport This support shall include e atool that selects windowing by mouse movement with the left or only mouse button held down e acceleration of the rate of windowing by a keyboard modifier or detection of the rate of mouse movement Another tool is provided to toggle between two modes of windowing behavior Center Width and Clamped When the Window tool is selected and the mode is Center Width e horizontal movement of the mouse to the right will widen the window width flatten the perceived contrast e vertical movement of the mouse upwards will lower the window center increase the perceived brightness When the Window tool is selected and the mode is Clamped e the bottom of the window shall be clamped to a rescaled pixel value of 0 e vertical movement upward shall lower t
44. ew Integration Profile and the relevant transactions between them 22 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 510 515 520 525 IHE Radiology Technical Framework Supplement Basic Image Review BIR Image Display Query Images 14 Retrieve Images 16 Image Image Manager Archive Figure 26 1 1 Basic Image Review Actor Diagram Table 26 1 1 lists the transactions for each actor directly involved in the Basic Image Review Profile In order to claim support of this Integration Profile an implementation must perform the required transactions labeled R Transactions labeled O are optional A complete list of options defined by this Integration Profile and that implementations may choose to support is listed in Volume 1 Section 26 2 Table 26 1 1 Basic Image Review Integration Profile Actors and Transactions Actors Transactions Optionality Section in Vol 2 3 Image Manager Archive Query Images RAD 14 R 4 14 Retrieve Images RAD 16 R 4 16 Image Display Query Images RAD 14 R 4 14 Retrieve Images RAD 16 R 4 16 See Note 1 Note 1 When an Image Display is grouped with a Portable Media Importer no network activity is required RAD 14 is not required and only the display requirements in RAD TF 2 4 16 4 2 25 of the RAD 16 Retrieve Images are applicable This is the case for example for the Portable Media Creator in the PD
45. from users overwhelmingly endorsed this preference 29 An ability to display the contents of any report regardless of format present on the media is required since the Media Creator has control of both the format of any report and the capabilities of any viewer that it includes on the media and the users regard this feature as vital 30 Performance benchmarks and targets are not defined for cine nor for synchronized display of multiple windows since it is difficult to define measures for these Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR 110 Volume 1 Integration Profiles Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR Glossary Add the following terms to the Glossary 2 1 Dependencies among Integration Profiles 115 Add the following section to Table 2 1 Integration Profile Dependencies in section 2 1 120 125 Integration Profile Depends on Dependency Type Comments Patient Information Reconciliation Scheduled Workflow Required for workflow content to manage Patient Information Reconciliation is an extension to this profile requiring that the workitems and or content be updated Portable Data for Imaging None None Basic Image Review
46. he upper limit of the window increase the perceived brightness Clamped mode shall be the default for NM and PET images When Clamped mode is selected if the DICOM provided or currently applied lower limit of the window is not zero it shall be set to zero There is no requirement to synchronize windowing between different viewports The currently applied window center and width for each viewport shall be displayed at all times either in a status bar or in an overlaid corner annotation Window selection by the user whether by default preset or manual adjustment shall be preserved when scrolling through images in a series and scrolling frames within a multi frame image and for display of multiple tiles in a viewport For CT images in Hounsfield Units user selectable window presets shall be provided which shall include presets for soft tissue brain lung and bone Others may be provided at the implementer s discretion For other modalities for which the pixel intensity does not correspond to a defined range of physical units and hence for which no user selectable window presets can be defined a default derived from the statistical characteristics of the image or series shall be available that makes use of the range of actual pixel values in the image to apply a window that results in a usable display For PET and NM images this statistically derived default shall have a lower level of zero The default preset and user se
47. ho Image 1 Cine Loop 54 US MF FrameSet 1 1 1 gt None Yes gt lt 54 gt gt lt Image 2 Measurement 1 US SF FrameSet 1 2 1 gt gt lt lt No Image 3 Measurement 1 US SF FrameSet 1 3 1 gt gt lt lt No Image 4 Cine Loop 60 US MF FrameSet 1 4 1 gt lt lt Yes gt lt 60 gt gt lt Image 5 Measurement 1 US SF FrameSet 1 5 1 gt gt lt lt No Series 2 Contrast Image 1 Recording 700 US MF FrameSet 2 1 1 gt lt lt Yes gt lt 700 gt gt lt Series 3 Analysis Image 1 Color Perfusion 60 US MF FrameSet 3 1 1 gt lt lt Yes gt lt 60 gt gt lt Image 2 Perfusion Curves 2 SC MF FrameSet 3 2 1 gt lt lt Yes 2 None lt 55 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 1185 THE Radiology Technical Framework Supplement Basic Image Review BIR Table F 1 2 Simple Case of all Single Frame Images Within Series Example CT Series A Image amp Comment of SOP FrameSet Frame Next Prior Cine Description Frames Class Identifier Series 1 Localizer Image 1 AP 1 CT SF FrameSet 1 1 1 gt None No Series 2 Lung Image 1 1 CT SF FrameSet 2 1 1 gt lt lt Yes Ge 1 CT SF gt lt Image 140 1 CT SF 140 gt gt lt Series 3 Bone Image 1 1 CT SF FrameSet 3 1 1 gt lt lt Yes Zei 1 CT SF gt lt Image 140 1 CT SF 140 gt gt lt Table F 1 3 Simple C
48. ic Viewer Option requires that the on board Image Display application shall execute all the required functions without requiring write access to local persistent storage e g the C drive but it is not precluded from using the local store if accessible 15 6 3 Disclaimer Limitations The Basic Viewer Option requires that the Image Display application shall not present the user with a disclaimer notice or any other form of display whether on the screen physical media or packaging to the effect that either e the images on the media are not for diagnostic or clinical use or e that the application itself is not for diagnostic or clinical use Nor shall the application require that the user agree to any such conditions before proceeding to use the application It is however permitted to present a disclaimer that the provider of the media and the application on the media have no control over the display hardware or state of display calibration or any other aspect of the viewing environment and that this alone may affect the suitability of the displayed images for diagnostic use This requirement is present because the ordering physicians or radiologists who receive the media may indeed be making decisions about the patients management that this constitutes clinical or diagnostic use even though it may not be the intent to perform the primary radiological interpretation and that it is inappropriate and unsafe to provide either degra
49. image serves to indicate on what side of the body a sagittal slice is located by reference to a corresponding transverse slice the Image Display shall also annotate sagittal images with a specific textual indication of whether or not a sagittal image is to the left of center or to the right of center this can be computed by the viewer from Image Position Patient 0020 0032 and Rows 0028 0010 Columns 0028 0011 and Pixel Spacing 0028 0030 relative to the three dimensional extent of the entire volume of all FrameSets 4 16 4 2 2 5 8 Annotation The Image Display shall display annotations in the corners of the viewport and or top window decoration of the view port These annotations shall consist of the content of selected DICOM attributes appropriate to the SOP Class The information required includes but is not limited to e Patient s Name 00100010 Patient s ID 0010 0020 Patient s Birth Date 0010 0030 Patient s Sex 0010 0040 e Institution Name 0008 0080 e Study ID 0020 0010 and Accession Number 0008 0050 for correlation with study described in the report e Series Number 0020 0011 for correlation with series described in the report e Series Description 0008 103E e Acquisition Datetime 0008 002A if present else Acquisition Date 0008 0022 and Acquisition Time 0008 0032 if present else Content Date 0008 0023 and Content 38 Rev 1 2 2012 07 24 Copyright 2012 IHE Internatio
50. in one FrameSet per Series occurs when e each Series contains multiple single frame images or e each Series contains only a single multi frame image More than one FrameSet is required per Series when that Series contains a mixture of single frame and multi frame images 53 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR The following example applies the rules of Section 4 16 4 2 2 5 2 to define FrameSets and shows e what navigation elements from Table 4 16 4 2 2 5 13 1 would be used to step forward and backward 1175 e whether or not cine tools are available for that FrameSet A hypothetical FrameSet Identifier and Frame within FrameSet is used to illustrate the grouping Note As per Table 4 16 4 2 2 5 13 1 the Right and Down arrow keys have the same effect as the gt Next Frame button and the Page Down key has the same effect as the gt gt Next FrameSet button etc 54 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 1180 THE Radiology Technical Framework Supplement Basic Image Review BIR Table F 1 1 Mixed Single and Multi Frame Images Within Series Example Ultrasound Series amp Image amp Comment of SOP FrameSet Frame Next Prior Cine Description Frames Class Identifier Series 1 Ec
51. ing Media data is used to enable diagnostic or therapeutic processes in environments without a reliable network connection The volume of data can be very large and may contain image data post processing results and reports In the operating room the surgical staff receives the media and reads its contents using advanced viewing capabilities which may include manipulating or processing images 15 3 2 Process Flow Description The use cases can be specified in terms of three media related activities e Media Export e Media Viewing e Media Import A Media Export All Use Cases The Portable Media Creator assembles the media content DICOM and optionally web viewable content and writes it to the physical medium The following sequence of activities will be performed during media creation e Export of DICOM data FSC activity e Optionally export of web viewable data which involves deriving easily accessible informative data from the DICOM data Web Content Option e Optionally inclusion of one or more viewers one or more of which may conform to the Basic Image Review Integration Profile Basic Viewer Option e Optionally inclusion of additional content te g aDICOM Viewer or viewing software componentson the media to aceess DICOM data B Media Viewing B1 Web Use Case 1 care providers other users and patients without DICOM viewing equipment or software 12 Rev 1 2 2012 07 24 Copyright 2012 IHE Internation
52. l set of play stop pause rewind reverse forward and end in order to support cardiac applications 8 Flip and rotate are not necessary for cross sectional images but these are needed for display of projection radiographs and scanned film which are often unfortunately not oriented correctly for viewing 9 There is no requirement for a next previous patient button when used on media with a single patient since there is no reading worklist to step through however for an Image Display not on media a patient selection tool is provided 10 Implementation of an interactive 3D localizer mechanism is thought to be excessively burdensome relative to its usefulness in a basic viewer and is not included 11 There is no requirement to provide a user warning required when a non supported SOP class is displayed 12 Contrast and brightness controls for true color images are not required 13 The list of required SOP Classes specifically excludes the retired NM and US and bi plane XA objects as well as the mammography and the visible light family 14 Presentation states and KOS objects are not included in the basic viewer either on media or off if support is required one can claim support for the CPI or KIN profile respectively 15 Should the application be required to automatically display images immediately or could this actually slow things down if the first study is not the one that is wanted and it is large Probably better not to re
53. lected windowing shall be applicable to grayscale images of any bit depth greater than one whether signed or unsigned including 8 bit images The window range shall be able to be extended beyond the pixel value range 34 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 835 840 845 850 855 860 865 IHE Radiology Technical Framework Supplement Basic Image Review BIR There is no requirement to be able to apply a pseudo color palette to grayscale images those with a Photometric Interpretation of MONOCHROME or MONOCHROME2 but this ability may be included at the implementer s discretion On a color monitor the Image Display shall be able to display color images those with a Photometric Interpretation of RGB or PALETTE COLOR and images that have a Planar Configuration of 0 or 1 There is no requirement to be able to control the contrast or brightness of a color image The grayscale rendering pipeline shall be appropriate to the SOP Class and modality If Rescale Slope and Rescale Intercept are present in the image for MR and PET and XA XRF images they shall be ignored from the perspective of applying window values and for those SOP Classes window values shall be applied directly to the stored pixel values without rescaling If VOI LUT tables or functions are specified in the DICOM images then the requirements of 4 16 4 2 2 1 Display of Digital X Ray Mammo and Intra Oral Images shall a
54. m the user selecting the thumbnail of any single series to the display of the first image of that series 2 seconds for any series 2 seconds for any series Series thumbnail select to last image of series displayed The time from the user selecting the thumbnail of any single series to the display of the last image of that series by the user scrolling to the last image and without skipping any images 20 seconds for 311 slice PET CT CT series 10 seconds for 21 slice MR localizer series Select different series Scroll frame rate When one series is already displayed the time after selecting a different series thumbnail until the first image of the new series is displayed With only one window displayed at the full size of the screen and the image fitted to the size of the window with all frames 2 seconds for any series 30 slices per second for 311 slice PET CT 512x512x12 bit 2 seconds for any series Rev 1 2 2012 07 24 20 Copyright 2012 IHE International Inc 475 IHE Radiology Technical Framework Supplement Basic Image Review BIR Benchmark Definition Target for Large Dataset Target for Small Dataset loaded and without skipping frames the rate at which frames can be scrolled Zoom time With only one window displayed at the full size of the screen and the image fitted to the size of the window the ti
55. me from the user initiating a zoom command by a factor of 2 approximately until the display of a stable unchanging magnified image 0 5 seconds orl 880 x 2016 DX PA Chest 20051208 Window center and width change response time With only one window displayed at the full size of the screen and the image fitted to the size of the window the time from the user initiating a windowing command until the display of a stable unchanging windowed image approximately 0 1 seconds near visually imperceptible orl 880 x 2016 DX PA Chest 20051208 Add Section 26 Rev 1 2 2012 07 24 21 Copyright 2012 IHE International Inc 480 485 490 495 500 505 IHE Radiology Technical Framework Supplement Basic Image Review BIR 26 Basic Image Review Integration Profile The Basic Image Review Profile defines baseline functions and user interface relevant to simple review of DICOM images and which attributes should be used to implement those capabilities The Basic Image Review Profile is designed to provide sufficient display functionality to allow adequate review of images for the purpose of clinical decision making by ordering physicians It does not address application or modality specific requirements such as may be needed for primary interpretation of mammography by radiologists or primary interpretation of nuclear medicine image which are addressed b
56. mouse button when clicked to begin a linear distance measurement at the location of the cursor and when clicked See 4 16 4 2 2 5 10 Rev 1 2 2012 07 24 50 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR again to end it Angle Measurement Z Acute angle with the opening spanned by an arc with arrows at both ends off A for angle Selecting this tool shall change the function of the left or only mouse button when clicked to begin a distance measurement at the location of the cursor and when clicked again to define the end of the first segment clicked again to begin a second segment and when clicked again to end it See 4 16 4 2 2 5 10 Cross hair tool Crossed perpendicular dashed lines in a circle off Selecting this tool shall change the function of the left or only mouse button when clicked to cause cross hairs to be displayed See 4 16 4 2 2 5 7 Shall be grayed out if no series are displayed on which to show cross hairs Table 4 16 4 2 2 5 13 3 Cine Tool Icons Appearance and Action Tool Icon Symbol Icon Ref or Desc Default State Key Action Comments Cine Play Cine Stop IEC 60878 2003 5107B Normal run On Off No default shortcut No default shortcut Pressing this button sh
57. n s into the relevant Technical Framework volume Replace Section X X by the following General information about IHE can be found at www ihe net Information about the IHE Radiology domain can be found at http www ihe net Domains index cfm Information about the structure of IHE Technical Frameworks and Supplements can be found at http www ihe net About process cfm and http www ihe net profiles index cfm The current version of the IHE Technical Framework can be found at http www ihe net Technical_Framework index cfm Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 55 60 65 70 75 80 85 IHE Radiology Technical Framework Supplement Basic Image Review BIR CONTENTS INTRODUCTION RE 4 PROFILE ABSTRACT r hess tele bericht ae Sen eo ae hee ee Re et ee ete Mts 4 OPEN ISSUES AND QUESTIONS ccccsssssecessececssccecseseeecsesseeecenseeceseeecsesaeeececeecessaeeeceesaeeeceesaecessueeessessececseaaeeeeseeeses 4 CLOSED EE A VOLUME 1 INTEGRATION PROFILES cssccccsssscesssscccssnsccecssscccessscccessscceessceccsssaceeessnsccsessceecsssaceeessneese 7 EI BR E AE 8 2 1 DEPENDENCIES AMONG INTEGRATION BROEILES esseeseenseeeeesseeeesseeeeesneeeees 8 2 1 13 Portable Data for Imaging OD 8 2 1 24 Basic IMAGE Review EE 9 15 PORTABLE DATA FOR IMAGING INTEGRATION PROFILE w cssscccesssccccssseccsssscccessssccecssseecees 10 15 2 PORTABLE DATA FOR IM
58. n shall cause the selected viewport to display the first frame of the first FrameSet of the next study if any and highlight the thumbnail of the newly selected FrameSet The operating system enables character repeat for Next Study Shall be grayed out if no next study Rev 1 2 2012 07 24 43 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Tool Icon Symbol Icon Ref or Desc Default State Key Action Comments Previous FrameSet lt lt Left facing double arrow Not applicable Page Up Pressing this button shall cause the selected viewport to display the first frame of the previous FrameSet of the current study if any and highlight the thumbnail of the newly selected FrameSet The operating system enables character repeat for Previous FrameSet Shall be grayed out if no previous FrameSet Next FrameSet Right facing double arrow Not applicable Page Down Pressing this button shall cause the selected viewport to display the first frame of the next FrameSet of the current study if any and highlight the thumbnail of the newly selected FrameSet The operating system enables character repeat for Next FrameSet Shall be grayed out if no next FrameSet Rev 1 2 2012 07 24 44 Copyright 2012 IHE Interna
59. nal Inc 980 985 990 995 1000 1005 1010 THE Radiology Technical Framework Supplement Basic Image Review BIR Time 0008 0033 if present else Series Date 0008 0021 and Series Time 0008 0031 if present else Study Date 0008 0020 and Study Time 0008 0030 e Instance Number 0020 0013 for correlation with slices described in the report e Slice Location 0020 1041 if present else Table Position 0018 9327 if present else a value derived from Image Position Patient 0020 0032 e Slice Thickness 0018 0050 e Spacing Between Slices 0018 0088 if present else a value derived from successive values of Image Position Patient 0020 0032 perpendicular to the Image Orientation Patient 0020 0037 e whether or not intravenous contrast was used C derived from Contrast Bolus Agent Sequence 0018 0012 if present else Contrast Bolus Agent 0018 0010 e whether or not lossy compression has been applied derived from Lossy Image Compression 0028 2110 and if so the value of Lossy Image Compression Ratio 0028 2112 and Lossy Image Compression Method 0028 2114 if present as per FDA Guidance for the Submission Of Premarket Notifications for Medical Image Management Devices July 27 2000 e the currently applied window center and width or window top and bottom for clamped mode Local regulations or accreditation requirements may mandate additional information specific to particular mo
60. ng and panning Window Center Width IEC 60878 On for NM No default Pressing this See 4 16 4 2 2 5 4 or Clamped Mode 2003 5435 and PET shortcut button shall The cursor icon on the images change the displayed during left with a Off for mode of windowing shall Bohr atom modalities windowing change to match symbol on the other than behavior for the the selected mode right with a NM and selected solid line PET viewport s underneath between changing the window center and width or adjustment of the upper value of the window with the lower limit clamped to zero Annotation Lines of text Full I for Selecting this There are at least in four corners annotation information tool shall cycle three states of no through the annotations full activation states annotations and of posting text an intermediate in the corners state with less of each than full viewport annotation See containing 4 16 4 2 2 5 8 annotations of demographics management location timing and technique 46 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Tool Icon Icon Ref Default Key Action Comments Symbol or Desc State Print Drawing of a Not P for print Pressing this This is intended Tf printer applicable button shall for printing A cause the reference images y currently on consumer selected gr
61. nizable no less than 128x128 pixels e be representative of the image content of the FrameSet eo down sampled from the central frame of a FrameSet e be decorated with text describing the Series Date or if absent Study Date Modality and Series Description derived from the standard DICOM attributes and a count of the number of frames in the FrameSet i e images in the series in the case of single frame images e bearranged within a scrolling strip or panel which is visible by default though optionally a mechanism may be provided for the user to hide the thumbnail strip or panel to minimize encroachment on available screen real estate for display 32 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR e besorted by ascending temporal order of study and then ascending temporal or ascending Series Number within a study and then ascending temporal order of images within a series in the case of multi frame images 760 The text decoration may overlay the thumbnail image or appear above or below it The Image Display shall allow the user to e double click over a thumbnail to load the corresponding FrameSet for display in the currently selected viewport replacing any FrameSet already displayed e CTRL click indows or Command click MacOS discontiguous thumbnails to 765 allow selection of two or optionally more FrameSets which after
62. nstances on the Media are specified in Rad TF 2 4 16 4 1 3 3 1 1 15 6 1 Platform Hardware and Software Requirements The Basic Viewer Option requires that the Image Display included on the media works under normal user privileges and does not require software installation Specifically the Image Display application shall be executable e from the PDI media e on the following minimum hardware and software e one x86 Intel or AMD processor or core e Windows XP Home Edition and Windows Vista Home Basic Edition e NET 2 0 framework installed e 512MB RAM for XP and 1024 MB RAM for Vista e graphics hardware and a single monitor of any type supported by Windows at 1024x768 resolution in 24 bit RGB color e amouse or other pointing device with a single button e one drive that supports reading writable CD and DVD media e aconsumer grade printer e without requiring installation of or permission to install applications frameworks such as Java or other NET versions libraries such as DLLs or ActiveX controls 15 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 340 345 350 355 360 365 370 375 IHE Radiology Technical Framework Supplement Basic Image Review BIR device or graphics drivers or software other than those shipped with the basic operating system e without requiring the presence of a network connection for download of software licensing or registration or exchange of any
63. ntations 37 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 945 950 955 960 965 970 975 IHE Radiology Technical Framework Supplement Basic Image Review BIR e the 3D location of the slice s in the currently selected viewport shall be displayed as a localizer line s on the other viewports e no localizer lines shall be displayed in the currently selected viewport A Localizer Lines tool shall be provided to turn the display of localizer lines on or off These requirements for the Basic Image Review Profile supersede the general requirements for all Image Displays described in 4 16 4 2 2 2 Display of Localizer Lines Specifically the contents of Referenced Image Sequence 0008 1140 shall be ignored in favor of what the user has selected for display in the viewports Another means of cross referencing shall be provided in which e selection of a Cross hair tool shall change the function of the left or only mouse button such that clicking on a pixel location within one viewport shall cause a crosshair to be displayed at that location in that viewport and at the corresponding 3D location in other viewports e the cross hair s shall consist of horizontal and vertical line segments which e may or may not span the full extent of each viewport e are interrupted in the center so as not to obscure the image at the pixel location Though ability to display the location of a slice on an orthogonal
64. nterface elements in this Section 4 16 4 2 2 5 29 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 650 655 660 665 670 675 680 685 IHE Radiology Technical Framework Supplement Basic Image Review BIR This shall be the default presentation Additional features may be present but in order to reduce confusion these shall not be displayed to the user unless the user specifically selects a tool to trigger advanced functionality With a multi button mouse the functions of the left mouse and middle scroll wheel are defined The right mouse button shall be inactive or bring up a context sensitive menu whose contents are unspecified 4 16 4 2 2 5 2 Layout Tiling Selection Rotation and Flipping Layout and navigation are defined with respect to FrameSets Each DICOM image instance is a separate FrameSet with two exceptions e a Series of only single frame instances comprises a single FrameSet e the combined frames of a Concatenation comprise a single FrameSet if Concatenations are supported which they are not required to be This means that when a Series contains a mixture of single frame and multi frame images in order to preserve sequence of images within a Series e each successive single frame image will be a separate FrameSet consisting of one frame e each multi frame image will be a separate FrameSet except for combined images of a Concatenation if supported
65. ocument Consumer shall use the just queried information or the most recently received instances to ensure that the most recent patient data from the Image Manger Archive or Imaging Document Source is displayed In the case of the Image Display encoded on PDI Media by a Portable Media Creator which supports the Basic Viewer Option the Patient information on the media shall be used The Image Display or Imaging Document Consumer shall be able to display the Series Description for each series displayed Amend Section 4 47 4 47 4 1 2 2 3 1 DICOM Media Viewer and Basic Viewer Option A Portable Media Creator that supports the Basic Viewer Option shall be capable of putting a DICOM Viewer that complies with the Basic Image Review Profile on the media The hardware and software requirements for the viewer are defined in the Basic Viewer Option of PDI RAD TF 1 15 6 1 52 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 1140 1145 1150 1155 1160 1165 1170 IHE Radiology Technical Framework Supplement Basic Image Review BIR e auser manual in PDF format be included on the medium in the root directory e a short manual in hardcopy be provided within the D jewelease physical media packaging e if the viewing software is not capable of executing properly e g wrong OS version insufficient memory insufficient display resolution the software should do nothing or terminate with an er
66. onization between viewports shall apply whether a single frame is displayed or the viewport is tiled to display multiple frames The user shall be able to unlink synchronization between viewports scroll one and then relink to a new synchronized position tee if the patient has moved between FrameSets within the same nominal DICOM Frame of Reference For cross sectional images that are in the same orientation but not in the same DICOM Frame of Reference the user shall be able to scroll them if needed to align them and then link them for subsequent scrolling When two cross sectional images in the same orientation are displayed in different viewports they shall default to the linked state if they have the same DICOM Frame of Reference otherwise they shall default to the unlinked state Only one synchronized set shall be provided Scrolling when multiple tiles are displayed in a viewport shall be snaked that is as the user advances one slice forward all slices shift to the left and upwards as appropriate but do not loop at either end of FrameSet 4 16 4 2 2 5 6 Zooming and Panning The Image Display shall provide continuous not stepped zooming and panning of an image displayed in a viewport A Zoom tool shall be provided to select zooming within the selected viewport by mouse movement with the left or only mouse button held down 36 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc
67. orter actor accesses all DICOM instances referenced by the DICOMDIR file and enables the user to select a media patient dataset to be imported The Portable Media Importer obtains local data that is known to be accurate within the importing institution enterprise and reconciles key attributes of patient and study information when required A method for performing these steps is documented in the Import Reconciliation Workflow Profile see Section 3 21 Refer to RAD TF 3 4 47 4 1 3 for the list of key attributes and the related reconciliation actions to be performed Note The Portable Media Importer may for example be grouped with an Evidence Creator to allow the storage of its diagnostic and therapeutic imaging content to an Image Manager Image Archive or grouped with a Report Creator to store reports and a Report Repository This enables use of the content for subsequent relevant prior data for future reads A grouping with an Acquisition Modality actor could also be used to allow subsequent reads over reads In the case of a Portable Media Importer grouped with the Print Composer actor the imported content images and presentation states can be sent to the Print Server to be printed 15 4 Media Content The requirements on media content are intended to promote the reliable transfer of imaging data including diagnostic reports and to allow for the viewing of images and reports on general purpose computers The medi
68. pply the Basic Image Review Profile does not waive those requirements further the Basic Image Review Profile extends these requirements to be applicable to any SOP Class with VOI LUT tables or functions including CR images Stored pixel values between Pixel Padding Value and Pixel Padding Range inclusive shall be suppressed always displayed as black and not windowed Display shutters encoded in the image shall be applied There is no requirement to provide new or adjustable display shutters An invert grayscale tool shall be provided It shall invert the displayed pixels but not the pixel padding background or shutters 4 16 4 2 2 5 5 Scrolling The Image Display shall provide support for scrolling in the currently selected viewport between images when multiple single frame images are present in a series and between frames when multiple frames are present in a single image i e frames within a FrameSet This support shall include e a Scroll tool that selects scrolling by mouse movement with the left or only mouse button held down e acceleration of the rate of scrolling by a keyboard modifier or detection of the rate of mouse movement e scrolling via the middle scroll wheel on a mouse if present on the hardware regardless of the left mouse button tool selection Unaccelerated scrolling shall not skip frames Vertical movement of the mouse upwards for cross sectional images shall scroll to slices physically behind the
69. quire this 16 The performance test reference platform need not be the same as the minimal configuration else performance would be disappointing 17 Referring physician users prefer auto run unless the site or the user has explicitly taken steps to suppress auto run 18 Consensus seems to be that mini localizers are undesirable and that a localizer or orthogonal image can be displayed in the second series viewport if necessary Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc IHE Radiology Technical Framework Supplement Basic Image Review BIR Issue Answer 19 Keyboard modifiers of mouse movement initiated actions window scroll are thought to be important for usability but no specific mechanism modifier key or movement rate detection is required 20 For usability it is important to define the direction of mouse movement effect for certain tools window scroll 21 The default ordering for series of images or multi frame images is specified to be space then time rather than just acquisition order since this simplifies comparison of series acquired in opposite directions 22 No modality specific annotations required in the corner of the displayed images this is left to the discretion of the implementer Modality specific profiles or national extensions could be more detailed 23 Icons are chosen to be intuitive and representative of common usage
70. quired or prohibited to make use of it Keyboard short cuts shall be case insensitive Table 4 16 4 2 2 5 13 1 Action Tool Icons Appearance and Action Tool Icon Icon Ref Default Key Action Comments Symbol or Desc State Select Patient Person Single No default Pressing this Shall be grayed available shortcut button shall out if there is only patient is bring up a a single patient selected if mechanism to e g on more than select which interchange one patient patient to media no patient is display in selected those contexts in which multiple patient information is available 42 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Tool Icon Symbol Icon Ref or Desc Default State Key Action Comments Previous Study lt Left facing arrow within folder Not applicable No default shortcut Pressing this button shall cause the selected viewport to display the first frame the first FrameSet of the previous study if any and highlight the thumbnail of the newly selected FrameSet The operating system enables character repeat for Previous Study Shall be grayed out if no previous study Next Study Right facing arrow within folder Not applicable No default shortcut Pressing this butto
71. rather than using IEC 60878 2003 by preference 24 A limited number of keyboard shortcuts for various tools are defined 25 26 Zip The performance requirements reference platform and the characteristics of a set of test images are thought to be representative of real world expectations and achievable Fusion overlaying of semi opaque pseudo colored PET images over CT images is considered out of scope and beyond a basic viewer considering the complexity introduced by the need for separate windowing tools opacity alpha value tools the need for re sampling if the field of view pixel size and or slice thickness and reconstruction interval are different However side by side synchronized scrolling of the CT and PET series without fusion is required There is a strong desire to label on which side of the mid line a sagittal is located however when only one side of the body has been imaged it is well nigh impossible to define the true center line this leads to the prospect of the medial sagittal of a left sided temporal bone acquisition being labeled right the benefits of this feature in the common case are thought by consensus of the users to outweigh the problems for special cases and to be required in addition to the localizer line capability 28 The initial default tool is specified to be scrolling on the assumption that scrolling will be more likely the first user action than say windowing Feedback
72. rement that the contents of new media that is inserted be read Closing and reopening additional studies on the media is addressed in the Basic Image Review Profile requirements which require the user to be able to select any series from any study for display and to change what is selected For all activities that take more than five seconds to complete including startup and reading of images from the media some indication of the relative progress towards completion is required A manual for the use of the viewer in PDF form shall be accessible on the media in the root directory and named VIEWER PDF though there is no requirement that a PDF reader be supplied and it is not included in the minimum platform requirements 15 6 5 Performance Requirements Recognizing the speed limitations of physical media like CD when loading software and large images or numbers of images users must have reasonable expectations of performance That said users have observed significant variation amongst viewers in this respect Accordingly in order to satisfy the users expectations benchmarks for specific activities are defined for a reference platform and reference set of images and modalities 18 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 455 460 465 470 IHE Radiology Technical Framework Supplement Basic Image Review BIR Support of the Basic Viewer Option requires demonstrating that these benchmarks
73. ror message explaining the problem in human understandable form e g not exception 0xf800 or sys12345 dll is missing and without negatively affecting other programs or the operating system i e the software should not crash the machine 4 47 4 1 2 2 4 Media Identification The Portable Media Creator actor shall support a user in adding human readable identification information on the outside of the physical medium The method of media marking is outside the scope of this integration profile It is recommended that the Patient Name patient ID birthdate media creation date the study dates for the studies on the medium and the name of the originating institution be marked on the medium It is also recommended that the type of content DICOM ONLY or DICOM PLUS WEB be marked on the medium If the Basic Viewer Option is used by the Portable Media Creator then the label shall include an indication that an IHE Basic Image Review viewer is present IHE PDI BIR Add Vol 2 Informative Appendix as follows Appendix F Organization of series and images into frame sets Section 4 16 4 2 2 5 2 defines the concept of a FrameSet that combines Series and Multi frame images to provide a consistent mechanism for navigation in order to provide the same user experience regardless of whether the same information is encoded as separate single frame images or a single multi frame image The simple case that results
74. splays it has specific requirements that pertain to the use of Image Displays included on 135 PDI media and is related to a named option for the PDI Profile Amend volume 1 section 15 PDI Profile to add options Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 140 145 150 155 IHE Radiology Technical Framework Supplement Basic Image Review BIR 15 Portable Data for Imaging Integration Profile The Portable Data for Imaging Integration Profile specifies actors and transactions that provide for the interchange of imaging related information on interchange media The intent of this profile is to provide reliable interchange of image data and diagnostic reports for import display or print by a receiving actor This profile addresses identification of the media content s source and the patient where appropriate reconciliation of data during import and the structure of the media contents The central elements of the profile are e Reliable interchange of imaging related information based on the DICOM standard e A Web Content Option that which provides guidelines for including web viewable content on media e A Basic Viewer Option which requires that there be at least one viewer present on the media that implements the Basic Image Review Integration Profile The Web Content Option addresses the case of media containing both DICOM encoded objects and objects in XHTML or JPEG derived from thes
75. th the capability to apply all the transformations specified by the VOI LUT Sequence 0028 3010 and the capability to apply all the transformations specified by the Window Width 0028 1051 Window Center 0028 1050 VOI LUT Function 0028 1056 attributes in the DX Image Module as selected by the user from the choices available e g guided by Window Center Width Explanation 0028 1055 or LUT Explanation 0028 3003 If VOI LUT Function 0028 1056 is absent then Window Width 0028 1051 Window Center 0028 1050 shall be assumed to be the parameters of a linear window operation VOI LUT Function 0028 1056 values of SIGMOID and LINEAR shall be supported 28 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc 620 625 630 635 640 645 IHE Radiology Technical Framework Supplement Basic Image Review BIR The Image Display or Imaging Document Consumer shall support the application of LUT Data 0028 3006 in items of the VOI LUT Sequence 0028 3010 regardless of the Value Representation i e the DICOM standard allows either OW or US Value Representation The Image Display or Imaging Document Consumer actor must also support pixel rendering according to the Grayscale Standard Display Function GSDF defined in DICOM 2008 PS 3 14 because the output values of these images are always P Values If the DICOM image is referenced by other DICOM composite objects such as Grayscale Softcopy Presenta
76. tion States it is optional for the Image Display or Imaging Document Consumer to actually retrieve and display apply these objects 4 16 4 2 2 1 1 Display of Digital Mammography Images The contents of this section are required for Image Display claiming the Mammography Image Profile 4 16 4 2 2 2 Display of Localizer Lines Image Display or Imaging Document Consumer actors that want to show the localizer lines if visible will be able to calculate the position of these lines of intersection based on the information recorded in the images by the Acquisition Modality actor See 4 8 4 1 2 1 4 16 4 2 2 3 Display of NM Images The contents of this section are required for Image Displays claiming the NM Image Profile 4 16 4 2 2 4 Display of Results Screens The contents of this section are required for Image Displays claiming the NM Image Profile 4 16 4 2 2 5 Display of Images for Basic Image Review The contents of this section are required for all Image Displays claiming the Basic Image Review Profile Additional requirements for Image Display actors included on PDI media by Portable Media Creators that support the Basic Viewer Option are described in the Portable Data for Imaging Integration Profile see RAD TF 1 15 6 4 16 4 2 2 5 1 Simple Restricted Feature Set The Basic Image Review Profile defines a specific simplified set of functions for the Image Display actor to make available to the user using only the prescribed user i
77. tional Inc THE Radiology Technical Framework Supplement Basic Image Review BIR Tool Icon Symbol Icon Ref or Desc Default State Key Action Comments Previous Frame within a FrameSet Next Frame within a FrameSet lt Left facing single arrow Right facing single arrow Not applicable Not applicable Left arrow and Up arrow single click of either application shall support both Right arrow and Down arrow single click of either application shall support both Pressing this button shall cause the selected viewport to display the previous frame of the current FrameSet if any The operating system enables character repeat for Previous Frame within a FrameSet Pressing this button shall cause the selected viewport to display the next frame of the current FrameSet if any The operating system enables character repeat for Next Frame within a FrameSet Shall be grayed out if no previous frame Shall be grayed out if no next frame Layout Within Viewport Layout Multiple Viewports Single viewport with 2x2 tiles with a dropdown decoration Four viewports with 2x2 tiles with a dropdown decoration 1x1 Depends on how many series selected for display No default shortcut No default shortcut Pressing this button shall present a drop down of selected grid sizes to use within a single viewport
78. tor has access to the data from a grouped actor or another source outside the scope of IHE The media is physically transported to a destination where the imaging related information contained on the media will be used The Portable Media Importer reads DICOM objects images presentation states key image notes evidence documents and reports on the media and imports them into the local information space The Portable Media Importer reconciles the data as needed e g to change the recorded Patient ID to the local Patient ID If some classes of DICOM objects are present on the media and cannot be imported the Portable Media Importer actor notifies the operator of the studies and series affected and makes clear that they are not supported by the importing application The Image Display which may be included on the media by the Portable Media Creator Report Reader Display or Print Composer reads the objects it supports and renders pon SE on m receiver s e EC The Gest usage scenarios of the data are described in the use cases below 15 3 1 Use Cases This profile is not intended to provide an archival solution Use Case 1 Patient Referring Physician Viewing Diagnostic and therapeutic imaging data such as images and reports is received on media potentially serving multiple use cases The patient or the referring physician can view the data either with a viewer application residing on the same media or previously installed
79. uired 40 Rev 1 2 2012 07 24 Copyright 2012 IHE International Inc THE Radiology Technical Framework Supplement Basic Image Review BIR 4 16 4 2 2 5 11 Viewport and Tool Selection Some tools and actions require that there be one or more viewports that are selected for 1055 example e loading a FrameSet designated by a thumbnail into the selected viewport e linking or unlinking FrameSets for synchronized scrolling zooming and panning A viewport is either e implicitly selected when any modal tool is clicked within a viewport 1060 e explicitly selected with the Select Viewport tool Multiple viewports may be selected by holding the CTRL key Windows or COMMAND Mac key whilst clicking within a viewport when the Select Viewport mode is active The initial default shall be that the upper leftmost or only viewport is selected The Image Display shall provide visual feedback to the user as to which viewports are 1065 selected e g a border highlight Once a modal tool has been selected it shall remain selected until the user explicitly selects another tool e g when the distance measurement tool is selected multiple measurements can be made without having to reselect the measurement tool Explicit selection of a viewport is not required prior to application of modal tools 1070 4 16 4 2 2 5 12 Report Display When used as the Basic Viewer Option on PDI Media the Image Display shall provide a Show
80. y other profiles The Basic Image Review Profile is intended to provide for display of grayscale and color images from any modality including cross sectional modalities like CT MR and PET projection radiography modalities like CR DX XA and XRF as well as ultrasound and nuclear medicine though it is not limited to any particular modality basic grayscale or color rendering of the images as encoded 1 e without additional image processing like pseudo coloring multi planar reconstruction volume or surface rendering or multi modality fusion visual navigation of the available series of single and multi frame images through the use of thumbnails side by side comparison of at least two sets of images whether they be multi frame images series from the same study or different studies with synchronized scrolling panning and zooming in the case of cross sectional modalities annotation of laterality orientation as well as spatial localization of cross sectional images for anatomic reference annotation of demographics management and basic technique information to provide for safe identification and usage simple measurements of linear distance and angle as used by clinicians for change detection and treatment planning cine capability to allow review of multi frame images that involve cardiac motion e g cardiac US XA CT or MR 26 1 Actors Transactions Figure 26 1 1 shows the actors directly involved in the Basic Image Revi

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