Presentation of Images with Annotations/Markups- Brief Proposal

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1. Proposed Workitem:

  • Proposal Editor: Michael Planchart/Peter Maton
  • Domain: Radiology

2. The Problem

CAD and clinical processing applications create processed images with annotations/markups. Different products are using different mechanisms for the markup, e.g.:

  • burned into the DICOM image,
  • encoded in the image overlay,
  • encoded in separate presentation state graphics,
  • encoded in a separate SR,
  • rendered onto the image in a separate JPEG

With so many mechanisms, display systems support some of them poorly or not at all, so workflow is disrupted and key information may be inaccessible. The variability also makes it very difficult to create robust hanging protocols.

Of all the methods available the DICOM Structured Report (SR) is the preferred one and by industry-wide consensus, to contain the encoded markups.

3. Key Use Cases

  • DR/CR Chest X-Ray Lung CAD:

Chest X-Ray Lung CAD devices process the digital images of AP/PA projections (frontal chest) obtained from the DR/CR modalities in order to detect nodules or abnormalities and to identify and mark the coordinates of the regions of interest (ROI).

The CAD processed output shall be delivered as a DICOM Chest CAD SR SOP Class to the PACS server.

The PACS image viewing workstation shall provide the means of toggling on off the markers atop the source image. The markers should be off by default on the PACS viewing workstation. The SR should be independently toggled from other overlays.

4. Standards & Systems

  • DICOM – Chest CAD SR SOP Class

5. Discussion

IHE has proven to succesfully develop profiles that harmonize the DICOM and HL7 standards to solve many integration problems where vendors were using disparate approaches.

A profile based on this proposal would allow vendors to implement the same functionality accross the board.

The profile would be tested during Connectathons to validate DICOM compliance.